Ending Hearing Disparities in Older Adults

Carrie Nieman was drawn into medicine by the combination of science and service, a vision that came into focus during her years at medical school at the University of Illinois in Chicago. There, she says, students learn to become immersed in the community and take on an advocacy role for their patients.

“I was raised as a medical student to think beyond that individual patient and what you can do to have an impact,” she says.

Now, as a fourth-year resident in Johns Hopkins’ Department of Otolaryngology–Head and Neck Surgery, she’s putting those ideas into practice in a big way through her study, Baltimore HEARS (Hearing Equality through Accessible Research & Solutions). For her dedicated research time during residency training, she’s studying a means to bring hearing to a population that’s been largely ignored: older, hearing-impaired adults who can’t afford the typical $3,000 to $5,000 cost of most hearing aids.

“The current thinking is that there are hearing aids or nothing,” Nieman explains. “Currently, there are not a lot of options for people who can’t afford this price and still want to do something about their ability to communicate.”

Seeking to change this disparity, she’s working with Johns Hopkins otologist Frank Lin—who has spent his career working with older adults and studying the impact of hearing loss on this group—to develop affordable, accessible interventions. The main focus of her work has been on bringing personal sound amplification products (PSAPs) to these individuals, along with the necessary device training and communication counseling. Though these technologies aren’t hearing aids and do not offer the full capabilities of aids, they accomplish much of the same purpose of turning up the volume of sounds important to everyday life without the high price tag.

Partnering with Weinberg Senior Living, a provider of subsidized housing for low- to moderate-income older adults in the Baltimore area, Nieman meets with individuals and their communication partners—such as a spouse, friend or relative—to develop a personalized plan to help them hear and communicate better. As part of Baltimore HEARS’ goal of accessible care, all visits take place at the individuals’ homes. All participants receive a basic exam and hearing screening to evaluate whether they need further audiological or medical evaluation. Through Baltimore HEARS, an individual chooses a listening device, learns how to use it and practices key communication strategies. Some residents choose PSAPs that function like a set of headphones—a separate microphone sits on a table near the source of the sound they’d like to amplify, such as the voice of a loved one. Others choose PSAPs that blur the line between these technologies and hearing aids, with a design similar to a single-ear headset like those used with cellphones. These wireless PSAPs have a directional microphone and can be adjusted to an individual’s specific listening needs.

To make sure that these interventions are having the desired effect, Nieman and her colleagues are studying how having a PSAP and the communication counseling affects not only the recipient—measuring quality-of-life factors such as their level of communication impairment, loneliness, depression and social engagement—but also their communication partners.

Though Nieman will end her dedicated research time soon and head back into the clinic, she emphasizes that this project will continue as she furthers her training. Through Nieman’s work with the Social Innovation Lab, she and her team developed an award-winning, sustainable business plan and founded a nonprofit, Access HEARS, to accelerate the transition from science to service.

“It’s important that hearing help for older adults isn’t based on whether or not they can afford an expensive device,” she says. “Working to end disparities will always be an important part of my career.”